Splenectomy Can Be Delayed in Transfusion-Dependent Thalassemia With Appropriate Chelation Therapy

Findings from a 30-year single-institution analysis reveal that splenectomy only partially decreased the need for transfusion in a small number of patients with transfusion-dependent thalassemia (TDT), suggesting splenectomy can be delayed with appropriate chelation therapy up to higher annual transfusion requirement values.

“Splenectomy is indicated in TDT only in certain situations,” wrote Tugberk Akca MD, Department of Pediatric Cardiology, Uludag University, Bursa, Turkey, and colleagues. “This study aimed to present the effectiveness, complications, and long-term follow-up results of splenectomy in children with TDT.”

For this study, Akca and colleagues performed an analysis of cases of splenectomy for TDT between 1987 and 2017 and their follow-up, until 2021. A total of 39 children, 24 females and 15 males, were included. The mean age at splenectomy was 11.2 years, and their mean follow-up duration after splenectomy was 21.5 years.

The response was defined according to the patient’s annual transfusion requirement in the first year post-splenectomy, as well as on the last follow-up year. Complete response was not seen in any of the cases, however partial response was observed in 32.3% of the cases. No response was observed in 67.6% of the cases.

In this study, researchers reported that thrombocytosis was observed in 87% of the patients. The platelet counts of 7 (17.9%) patients were >1000 (10⁹/L), and aspirin prophylaxis was given to 22 (56.4%) patients. The complications that they noted were thrombosis in 2 (5.1%) patients, infections in 11 (28.2%) patients, and pulmonary hypertension in 4 (10.2%) patients.

In conclusion, “Our study showed that after splenectomy, the need for transfusion only partially decreased in a small number of TDT patients,” Akca and coauthors concluded. “We think splenectomy can be delayed with appropriate chelation therapy up to higher annual transfusion requirement values.”

Source:

Akca T, Ozdemir GN, Aycicek A, Ozkaya G. Long-term Results of Splenectomy in Transfusion-dependent Thalassemia. J Pediatric Hem/Oncol. Published online April 19, 2022. doi:10.1097/MPH.0000000000002468